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Yifei Duan, Jennifer Sweet, Charles Munyon and Jonathan Miller

segments, although only the proximal segment reached statistical significance. Lower: The degree of atrophy of the proximal nerve was significantly correlated with degree of compression seen at surgery. There was no correlation between distal atrophy and degree of neurovascular compression. * p < 0.05, paired-sample Student t-test. When proportional atrophy compared with the contralateral side was analyzed based on outcome, opposite trends were observed for different segments of the nerve ( Fig. 3 ). Atrophy of the proximal trigeminal nerve was slightly greater in

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Neurosurgical Forum: Letters to the Editor To The Editor Ajith J. Thomas , M.B.B.S. Henry Ford Hospital, Detroit, Michigan Mathew J. Chandy , M.S., Mch. (NEURO) Christian Medical College Hospital, Vellore, India 943 944 We read with great interest the article by Naraghi, et al. , on whether neurovascular compression is a possible etiological factor in essential hypertension (Naraghi R, Gaab MR, Walter GF, et al: Arterial hypertension and neurovascular compression at the ventrolateral

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Sait Naderi, Feridun Acar, Göksemin Acar and Süleyman Men

is a major vasodepressive area in the brainstem. 3 Anatomical and functional data indicate that caudal VLMO neurons inhibit sympathoexcitatory neurons in the rostral VLMO and that inhibition is probably mediated by γ-aminobutyric acid. 3 Clinical observations indicate that neurovascular compression of the left rostral VLMO may cause intractable essential hypertension. Recent reports have demonstrated a close relationship between microvascular compression, especially at the root entry zones of the left glossopharyngeal and vagus nerves, and medically refractory

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Changhu Liang, Yinglin Du, Xiangtao Lin, Lebin Wu, Dawei Wu and Ximing Wang

conventional MR imaging. With the development of microanatomical surgery and microsurgery, microvascular decompression has been the primary method for treating oculomotor nerve paralysis. Familiarity with neurovascular relationships and detection of neurovascular compression are thus very important for preoperative planning and for providing a more accurate decompression procedure. 10 Three-dimensional CISS is a high spatial resolution, refocused gradient-echo MR imaging sequence that is flow compensated. The 3D CISS sequence depicts small structures surrounded by CSF with

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Neurosurgical forum: Letters to the Editor To The Editor Yildirim Bayazit , M.D. Gaziantep University, Kolejtepe, Turkey 1072 1073 I read with great interest the article by Hiroshi, et al. (Hiroshi R, Seiji Y, Kenji S, et al: Neurovascular decompression of the eighth cranial nerve in patients with hemifacial spasm and incidental tinnitus: an alternative way to study tinnitus. J Neurosurg 88: 232–236, February, 1998). The authors proposed that neurovascular compression (NVC) may be a cause of tinnitus. I

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Angelo Franzini, Vidmer Scaioli, Filippo Leocata, Elena Palazzini and Giovanni Broggi

structures. Focal myokymia is usually reported as occurring after radiotherapy of the brachial plexus and in chronic as well as acute peripheral nerve injury. 10 In our patient the condition was not associated with nerve damage: electrophysiological examination revealed normal nerve function. There are three indicators in this case that suggest that myokymia and pain may be due to neurovascular compression: 1) the surgical findings of anomalous arterial—nerve contact; 2) the transient attenuation of bioelectrical activity on ischemic testing; and 3) the abolition of

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Hiroshi Ryu, Seiji Yamamoto, Kenji Sugiyama and Kenichi Uemura

. Bilateral vestibular functions were normal for caloric responses, gaze nystagmus, saccadic eye movements, the eye tracking test, and optokinetic nystagmus. Computerized tomography and magnetic resonance imaging showed no abnormalities. The possibility of neurovascular compression syndromes was also checked using magnetic resonance imaging 3 but no vascular compression was detected. At first, we hesitated to perform total sectioning of the eighth cranial nerve because the patient's hearing on the left side was almost normal. After the procedure, the patient would

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Goro Otsuka, Kiyoshi Saito, Tazuka Yoshida, Yoshio Suzuki and Jun Yoshida

in a hemorrhagic bone cyst similar to hemophilic pseudotumor. To prevent neurovascular compression as well as to obtain a diagnosis, resection is recommended. 2, 3 When possible, total resection is preferable to reduce the possibility of recurrence. References 1. Chorobski J , Davis L : Cyst formations of the skull. Surg Gynecol Obstet 58 : 12 – 31 , 1934 Chorobski J, Davis L: Cyst formations of the skull. Surg Gynecol Obstet 58: 12–31, 1934 2. Horton DD , Pollay M , Wilson DA , et al

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Yukinari Kakizawa, Tatsuya Seguchi, Kunihiko Kodama, Toshihiro Ogiwara, Tetsuo Sasaki, Tetsuya Goto and Kazuhiro Hongo

vascular compression on the distal portion rather than the TZ. We are not sure whether compression of the distal portion of the facial nerve causes HFS given that in the present study there were individuals with such findings but no symptoms. Magnetic Resonance Imaging In the past, the use of conventional MR imaging has not proved useful in determining which patients with vascular contact might benefit from MVD because of a high prevalence of neurovascular compression in control individuals. 35 In addition, a study of the combination of sequences on 1.5-T MR

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-slice MR imaging or surgical exploration may be the most promising candidates for improvement following microvascular decompression. Only with prospective investigation and rigorous outcome criteria will we be able to identify the population who can benefit most from microvascular decompression of the lateral medulla. We have recently embarked on such a study. References 1. Akimura T , Furutani Y , Jimi Y , et al : Essential hypertension and neurovascular compression at the ventrolateral medulla oblongata: MR evaluation. AJNR